Implementing PACS on a shoestring

Good afternoon, KMart shoppers, don't miss our spring hospital PACS special in the electronics department. Buy two, get one free.

It hasn't quite come to that, but anyone interested in purchasing PACS on a shoestring budget would have appreciated Paul Nagy's SCAR University "PACS cheapskate" pitch Friday morning.

Nagy, an assistant professor of radiology at the Medical College of Wisconsin, cited several areas where cost-cutting is possible .

"Use COTS (commercial off-the-shelf) hardware whenever you can get away with it, including servers, computers, storage, and monitors," he said.

It's usually not necessary to purchase high-end vendor monitors when adequate commercial monitors are available at five to 10 times less.

No one should pay more than 30% of the cost of PACS for hardware, and it might be a good idea to build your own system, Nagy said. Pricewatch.com and PriceGrabber.com are good sites for finding bargain hardware.

The life expectancy of hardware is only one or two years, so it doesn't pay to invest too heavily. That allows 70% of your budget to be spent on software.

Within four years, desktop 40-GHz PCs with 1.5-TB hard drives and 12 MB RAM will be available, Nagy said. By 2011, there will be 150-GHz computers with 6-TB hard drives.

Storage is so cheap now that it is easier and less expensive to buy more capacity than to delete data from the system. Ten years ago, 10 TB of storage cost $12 million. Today, it costs $40,000, he said.

Since no PACS can be expected to last more than five years, Nagy advises planning an exit strategy right from the beginning.

Remember that vendors are not your best friends, but neither are they your enemy, he said.

"Learn what you can from them, but let market competition be your best friend," he said. "It's not good to get down to one vendor too soon."

Having an onsite vendor FTE is not necessary. Instead, pay for your own PACS expert. Vendor FTEs aren't under your control, and their presence involves an inherent conflict of interest, he said.

Finally, if your site does no more than 40,000 to 50,000 exams a year, it might be better to use an application service provider.

"ASPs were flimsy in the beginning, but they're more mature now," Nagy said.